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Biomedical Research in the Age of Preventive Medicine

“Moonshot” was the word Google CEO Larry Page used to describe his newest venture, Calico–a biotech startup focused on the challenge of aging and age-associated pathology. In fact, medical therapies to delay aging are increasingly feasible, and, as shown by our study in Health Affairs, could achieve a far greater return on investment than comparable advances in the treatment of specific diseases.

While our study provides the first clear economic justification for concerted social investment in delayed aging, biomedical researchers have already made impressive progress towards its technical realization. This year, researchers from Harvard and the University of New South Wales (UNSW) hope to begin human clinical trials for a compound found to dramatically reverse the aging process in mice. “People think anti-aging research is about us wanting to make people live until they are 200,” says Dr. Nigel Turner, a senior research fellow at UNSW, “but the goal is really to help people be healthy longer into old age.”

The exceptional value of delayed aging comes from a re-alignment of medical research and innovation with the health challenges of an aging population.
Historically, medical research has focused on improving the diagnosis and treatment of specific life-threatening illnesses such as cancer or heart disease. This “disease model” approach dramatically increased American life expectancy over the past 50 years, but has proven less effective in safeguarding the health of the resultant elderly population. Frailties associated with biological aging increase susceptibility to a cluster of chronic, disabling or lethal conditions–treat one and another soon takes its place. These competing risks diminish the disease model’s utility until, as seems to have occurred since 2002, gains in life expectancy are matched or even outpaced by rising disability rates. The unsustainable consequence is that each year more people spend more of their lives in worse health.

Stagnation in elderly health outcomes coupled with the population’s explosive growth–expected to more than double from 43 million in 2010 to 106 million in 2060–now threatens the American medical system’s integrity. What is needed is a new direction for medical research that will build on our past gains in longevity, but also ensure that these additional years are spent in good health. Medical advances which delay aging, simultaneously forestalling all associated health risks, are a logical means to achieve this goal.

Using the Future Elderly Model (FEM), a microsimulation of the future health and healthcare spending of Americans over 65, we quantified the social and economic benefit of a switch from our current disease model to one that addresses the condition of aging itself. For reference, we first simulated the status quo in which medical research continues to improve the diagnosis and treatment of specific diseases. The FEM showed that a 25% reduction in cancer or heart disease over the next two decades would yield only a modest one-year improvement in life expectancies, with disability rates nearly identical to those observed today. These results confirm that an aging population will not substantially benefit from continued achievements within the conventional disease model.

We then explored how medical improvements which delay aging would affect the same growing demographic of American seniors. To simulate the effects of a medical treatment which delayed aging, we designed a scenario in which population susceptibility to chronic or disabling conditions would decrease over the next two decades, resulting in a 20% reduction in age-related disease mortality for persons over 50 by 2050. Where reductions in heart disease and cancer improved life expectancy by around one year, the delayed aging scenario saw an improvement of 2.2 years and a 15% rise in the number of non-disabled, healthy seniors. Even using a conservative approach, the social value of such an increase in health and longevity would be worth approximately $7.1 trillion over the next 50 years.

Our results are the first to quantify the potential economic and societal gains from medical investments in delayed aging. Viewed against the diminishing returns from conventional medical research within the disease model, these gains become even more valuable.

However, delayed aging is not without its own set of particular challenges. Policy makers must consider how demographic shifts resulting from delayed aging will affect entitlement programs such as Social Security and Medicare.

The 15% reduction in disability rates will certainly shrink per-capita healthcare spending, but a nearly 7% growth in the population over 65 still yields a net increase of entitlement budgets by $420 billion, the majority from Medicare and Medicaid. Current proposals to increase the age of program eligibility would more than accommodate these new costs, and delayed aging may in fact make these proposals more politically feasible if it can improve health disparities suffered within the current disease model.

Many segments of our society can still greatly benefit from improvements in disease-specific diagnosis and treatment. For instance, while African Americans represent 13% of the population, they account for one quarter of cardiovascular disease deaths according to the Centers for Disease Control. Policies including the Affordable Care Act, which seek to address health disparities, focus on underlying causes including lifestyle choice and access to primary and preventative care. Promotion of health equity through early disease prevention and management is an opportunity to continue improving public health within the disease model.

As the disease model increasingly turns to the problems of health care access and management, biomedical investment and innovation must make a plan to meet the unprecedented needs of the population’s fastest growing demographic. The substantial health and economic benefits shown by our study, recommend that investment in delayed aging research should become an integral part of that strategy.

This post was coauthored by Dana Goldman and Arthur Simons. This post was originally published on LinkedIn



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